Electrical stimulation modalities (this would include ANY electrical stim delivered through surface or implanted electrodes - like TENS, Interferential, muscle stimulation, Russian currents, H wave and a whole host of others) are best avoided anywhere if you have a pacemaker. The delivery of an electrical current from an external source has the potential to cause interference with the operation of the pacemaker and whilst some pacemakers are fine, others are not, and there have been reports in the literature of interference and problems.

It is argued that applying TENS to the low back (for example) is far enough away not to be a problem BUT given that this is not yet established, the safest thing is to NOT USE ANY ELECTRICAL STIMULATION for ANY person who has a pacemaker fitted.

Information courtesy of Professor Tim Watson- leading expert in Electrotherapy.

Pain is the body’s warning system. It alerts us to injury or illness. When the body is functioning normally, pain serves as a vital warning sign when something is not right.

Pain signals, in the form of electrical impulses, travel through the body’s nervous system from the site of injury or ailment to the brain. Then, at the brain, these impulses are interpreted as pain.

TENS MACHINE PAIN RELIEF

There are two main methods that a TENS machine uses to provide you with pain relief.

Pain Gating

Endorphin Release

PAIN GATING

There are millions upon millions of small nerve fibres throughout our bodies which allow the sensation of pain to be felt. As well as these, the human body is also equipped with thicker nerve fibres. These carry less unpleasant sensations such as warmth, touch and the position of our joints, helping us to form an impression of our environment.

The sensation of touch is particularly relevant when considering pain, since as we know, if someone accidentally knocks their elbow, they instinctively rub it. This rubbing action excites the larger nerve fibres, which in turn, have an effect on the transmission of signals from the smaller “pain-carrying” nerves. Luckily, your brain can only interpret a limited amount of information. If the “rubbing” sensations outnumber the painful “bump” sensations, the brain will interpret the sensations as being from the pain-free rubbing source rather than the painful bump. In other words, the rubbing sensations have ‘bombarded the gate’, so painful messages cannot get through.

The Gate Control Theory was initially proposed in 1965 by Melzack and Wall based on the fact that small diameter nerve fibres carry pain stimuli through a ‘gate mechanism’ but larger diameter nerve fibres going through the same gate can inhibit the transmission of the smaller nerves carrying the pain signal. This theory lead to the development of TENS units which are designed specifically to stimulate the large nerve fibres.

ENDORPHIN RELEASE

According to the second theory, T.E.N.S. stimulation encourages one’s body to produce and release greater amounts of a chemical called endorphin. Endorphins are our body’s own natural painkillers that are released as a natural function to overcome pain. Endorphins interact with pain receptors, blocking the perception of pain, much as the pharmaceutical drugs or narcotics such as morphine do, but without the side effects associated with these types of drugs. . Endorphins are released by the descending nerve fibres or nerves which travel down the spinal cord from the brain.

When we feel pain, the descending nerve fibres release endorphins at the spinal cord, where they meet the sensory nerves carrying the 'pain messages’ from our body. This local release of endorphins by the nerves inhibits some or all of the pain messages going up to the brain.

A great example of endorphin release is the natural 'high’ that runners and other athletes experience after 30 minutes of sustained exercise. Much like exercise, the endorphin release stimulated by the TENS may take up to 30 minutes or more to take a noticeable effect. The “feel good” effect may last several hours before endorphin levels in the body need to be increased again.

The wide range of variation in machine settings and electrode positioning gives great flexibility in terms of treatment options. Don’t be afraid to experiment with the control settings or the placement of electrodes.

You may also find that your G.P, Physiotherapist, Osteopath or Acupuncturist can advise you on machine use specifically for your condition.

Treatment time in the conventional mode can be from 5 - 60 minutes with 20 minutes usually being sufficient. If used for longer than 1 hour then switch off for 5 minutes to reassess.

If good pain relief has been achieved with the conventional mode and then it becomes less effective this may be due to accommodation. Accommodation is when the nerves can become more tolerant to the TENS stimulation, reducing some of its effectiveness. The effects of accommodation can be greatly reduced by switching to MODULATION MODE. This is easily done using all the settings as before but switching the Mode Selector Switch from C (Constant) to M (modulation). This mode offers a gradual rise and fall type of stimulation that can feel very pleasant. MODULATION MODE can be utilized with any of the primary stimulation modes, but is particularly effective with the conventional method.

If after using the TENS machine for 40 minutes in the conventional mode you have not obtained relief then first try readjusting your electrodes. If after another 40 minutes you are still having pain then you may wish to experiment with one of the other modes available.

Above is a chart of the PRIMARY STIMULATION MODES giving the settings to be used and a comparison of the modes. In addition to the primary stimulation modes a number of other settings have been found through studies to be successful in treating various conditions. We therefore also include a list of some of the alternative settings available.

This may all sound rather confusing but once you have found the settings that suit you best you will find the machine easy to use and very worthwhile.

Most people have experienced back pain sometime in their life. The causes of back pain are numerous; some are self-inflicted due to a lifetime of bad habits. Other back pain causes include accidents, muscle strains, and sports injuries. Although the causes may be different, most often they share the same symptoms, like an ache, tension or stiffness in the back. In most cases, it gets better within 12 weeks and can usually be successfully treated by taking painkillers and keeping mobile.

A TENS machine is widely used by back pain sufferers to help manage and reduce the pain.

In TENS therapy for pain management, a small, battery-operated device delivers low-voltage electrical current through the skin via electrodes placed near the source of pain. The electricity from the electrodes stimulates nerves in the affected area and sends signals to the brain that “scramble” normal pain perception.

Suggested electrode placement and settings for LOWER BACK PAIN

Using both leads, position the electrodes either side of the spine, at the site of pain.

Can TENS and Muscle
Stims (EMS machines) be safely used by people with metal implants?

This is a question
Natures Gate often get asked and the answer is yes. Many people who have had pins, plates, wires,
nails or screws to reconstruct or replace their malformed or degenerated
joints find that TENS machines are useful for their pain relief and muscle
stimulators are useful with their rehab.
They are however concerned if these are safe to use.

Metal implants (most commonly) hip and knee replacements
are widely considered to constitute a contraindication to most, if not all
electrotherapy modalities - though in fact studies have shown that this is not
actually the case for many.

When considering
electrotherapy to treat conditions it is important to determine if the device
is PASSIVE or ACTIVE.

TENS and muscle
stimulators (also known as EMS, NMES or NMS machines) are battery powered and
are categorised as PASSIVE devices.

The major concern
is that the applied energy will result in ‘significant’ heating of the metallic
implant, which would have a detrimental effect in the local tissues surrounding
that implant, raising the tissue temperature to damaging levels. Whist that would
almost certainly be true for some electrotherapy modalities (most especially
the high frequency heating modalities - shortwave and microwave in particular),
it is not true for many others.

Electrical
stimulation modalities (TENS, Interferential, NMES etc) are not contraindicated
as the amount of energy applied is not sufficient to cause a detrimental
heating effect in the tissues surrounding the implant, though the presence of
metal in the tissues will almost certainly distort the pathway taken by the applied
current and may therefore generate some unexpected effects in terms of
sensation experienced by the patient. Passive metal implants are NOT therefore
a contraindication to the electrical stimulation modalities (ACTIVE implants
are though)

We always recommend
that you also consult with your doctor and always fully read the User Guide for
all Natures Gate units and pay particular attentions to our Contraindications,
Precautions and Warnings.

Anyone who has ever experienced a chronic pain condition knows just how debilitating pain can be. It’s hard to explain to someone who has never experienced chronic pain how different chronic pain is compared to a pain that is expected to go away, such as an injury or an accident.

Chronic pain wears the body down, stresses the adrenals and kidneys, and puts emotional and physical stress on the body and mental stress on the brain. Unfortunately, the predominate way of treating chronic pain in a medical setting is to use medication, many that are quite harsh and have undesirable side effects.

Possible side effects of painkiller

Taking painkillers is good only to a certain extent. While side effects vary from painkiller to painkiller, it helps to be aware so that you may ask your doctor the right questions before taking these drugs:

Constipation is the most common side effect of painkillers.

Many painkillers also cause drowsiness.

Painkillers may cause damage to the liver and kidney.

Cardiovascular and respiratory systems get affected; due to the slowing effect painkillers have on the heart and respiratory rates.

Painkiller addiction is a serious problem globally, as the numbing of pain and the sedative effects of painkillers can be pleasurable and therefore habit-forming.

Painkillers with opiates can also cause hallucinations, disturbed sleep and confusion.

Many pain medications evoke skin itchiness and dryness.

For those suffering from chronic pain, there are some ways to reduce pain and manage it, without resorting to medication, or ways to manage pain while limiting the need or dependence on pain medication.

T.E.N.S. or Transcutaneous Electrical Nerve Stimulation is a small device that many people find effective in relieving pain. TENS has become a recognised and well-proven method of treating pain.

How does TENS work?

TENS relieves pain in two ways. Electrical pulses pass from the machine through electrodes placed over the nerve centres. Benefit is felt firstly by blocking the pain signals normally sent to the brain through the nerve fibres, thereby interrupting the brain’s awareness of pain. Secondly, the body is stimulated to increase its own production of natural painkillers known as endorphins and enkephalins.

What are the advantages of TENS?

TENS is an effective form of pain relief

TENS is safe

TENS is drug free

TENS is non-addictive

TENS is portable and ideal for home use

So before you next “pop a pill” consider using a TENS machine to help relieve your pain.

Electronic muscle stimulator (EMS) units use continuous electrical bursts aimed at particular muscles to force them to contract and relax. During muscle stimulation the body sends blood and oxygen to these areas and increases production of endorphins. Electronic muscle stimulator units are regularly used for Training, Rehabilitation and Recovery

SPORTS TRAINING

Dr. Y Kots of the Central Institute of Physical Culture in the former USSR conducted a study showing that electronic muscle stimulation causes contractions that are up to 30 times more powerful than normal voluntary contractions. This leads to enhanced muscle strength and improved muscle recovery.

REHABILITATION

Electronic muscle stimulator units can help rehabilitate muscles that have been injured due to traumer, surgery or disease. The contractions caused by the EMS help to strengthen muscles of individuals who may not be able to participate in physical therapy.

MUSCLE ATROPHY

Muscle atrophy is a symptom characterised by decrease in muscle mass and can occur as a result of numerous medical conditions. Electrical muscle stimulation may be used to slow or prevent the effects of muscle atrophy by keeping weakened muscles active.

OSTEOARTHRITIS

Osteoarthritis is a painful and sometimes debilitating condition caused by the degradation of joint tissues. According to a clinical study published in the “Archives of Physical Medicine and Rehabilitation,” electrical muscle stimulation was found to be an effective component of physical therapy for elderly patients who developed hip osteoarthritis after total hip arthroplasty surgery. Also an important benefit for mobility and independence, electronic muscle stimulation can strengthen knee extensor muscles.

PRESSURE SORE PREVENTION

Electrical muscle stimulation can effectively reduce the risk of pressure sores in prone patients. Pressure sores are common problems for patients who are wheelchair or bed bound. Electrical muscle stimulation can be applied to the gluteus maximus of wheelchair bound patients. This treatment can produce significant results regarding the maintenance of proper buttock shape and avoidance of deformities, which may be effective in reducing the incidence of pressure sores.

Electrical stimulation modalities (this would include ANY electrical stim delivered through surface or implanted electrodes - like TENS, Interferential, muscle stimulation, Russian currents, H wave and a whole host of others) are best avoided anywhere if you have a pacemaker. The delivery of an electrical current from an external source has the potential to cause interference with the operation of the pacemaker and whilst some pacemakers are fine, others are not, and there have been reports in the literature of interference and problems.

It is argued that applying TENS to the low back (for example) is far enough away not to be a problem BUT given that this is not yet established, the safest thing is to NOT USE ANY ELECTRICAL STIMULATION for ANY person who has a pacemaker fitted.

Information courtesy of Professor Tim Watson- leading expert in Electrotherapy.

Pain arises from any number of situations. Injury is a major cause, but pain may also arise from an illness. It may accompany a psychological condition, such as depression, or may even occur in the absence of a recognizable trigger.

Acute Pain

In normal development, acute
pain protects us from damage as we learn what is hazardous to us. It will also limit accidental damage by
causing us to withdraw from the painful stimulus and avoid it in the
future. Acute pain will also prevent us
from further damaging that segment by encouraging us to limit movement until it
has healed. In most cases, as the
injured tissue repairs itself, the pain will gradually diminish until we can
again function normally.

Chronic Pain

There are occasions when the
pain does not resolve on healing. Pain
then is no longer a symptom of injury, but becomes a problem in its own
right. This type of pain is described as
chronic pain.

·
To help the electrode to adhere, first of all,
clean and dry your skin using regular soap and water, but do not use
alcohol. Alcohol will dry your skin and may increase irritation with the
use of electrodes.

·
After removing the electrode, try using aloe
vera gel on your skin to help with sensitivity.

·
If the pad feels “mushy” it has absorbed
moisture from your body, and after cleaning, let it dry a little before storing
in the plastic pouch (this happens frequently in hot, humid weather). This
over-saturation will cause the electrode to come apart. If it gets too dry and
not tacky, rub a couple drops of water on the pad.

·
Using any gel or lotion before putting the electrode on will only
reduce its adherence, thus you would feel like you would need tape, etc.

Skin Irritation

·
If you do encounter skin
sensitivity, avoid placing electrodes in the same place until the skin
heals.

·
Turning on your TENS too high or
leaving it on for too long can result in over-stimulation and may cause skin
problems. Try using Hypo Allergenic or Latex Free electrodes. There are so many variables with each person
that it seems to be “trial and error” in many instances. There is not one electrode
that’s perfect for everyone because of differences in everyone’s skin and body.

·
If irritation still occurs,
discontinue use and consult your health care advisor.

For conductivity and adherence, the
best thing you can do is to keep the electrode clean and keep yourself well-hydrated.

The key here is the NERVE
part. TENS is a “pain blocker.” The tingling sensation from the
TENS machine helps to block the pain signal from the nerve to where it is
perceived in the brain as pain.

T.E.N.S. units are also
thought to aid in the release of endorphins, which are the body’s natural pain
fighting mechanism.

E.M.S stands for Electrical
Muscle Stimulation.

The key here is the
waveform that it outputs is different than that of a T.E.N.S and it affects
MUSCLE. A muscle stim targets muscle and stimulates them to alternately
contract and relax. The main application
of EMS is in the toning and strengthening of weakened muscles for athletic
purposes or for medical reasons. In addition to having a different waveform, it
also has what is called “Timing Options” including Ramp ON/OFF times, “ON/OFF”
times and sometimes a “Delay.”

The ramp
times are the amount of time that the unit takes in each cycle to ramp up to
the maximum intensity. The ON TIME is the time that the intensity is on
in each cycle and the OFF Time is the amount of time the unit is off in each
cycle. The cycle repeats. This causes a muscle to slowly reach
contraction (RAMP ON), stay contracted for a short period of time (ON TIME),
slowly release the contraction (RAMP OFF) and then rest before the cycle
repeats (OFF TIME). The timing options make it possible for the muscle
stimulator to do a “pseudo exercise” for the weak muscle.

In
conclusion T.E.N.S. units affect NERVE endings and are used for PAIN RELIEF.

Muscle
stimulators affect MUSCLE and are used to rehabilitate muscle.

Each has
a different waveform and the Muscle Stimulator has TIMING OPTIONS, whereas the
T.E.N.S. does not.

Fibromyalgia syndrome (FMS) is a musculoskeletal pain and
fatigue disorder for which the cause is still unknown. Fibromyalgia means pain
in the the fibrous tissues in the body i.e. the muscles, ligaments and tendons.
The main symptom of fibromyalgia is severe muscle pain but it can also be
accompanied by: fatigue, chest pain, headaches, fever, abdominal pain,
insomnia, swollen lymph nodes, irritable bowel syndrome and depression.

Does
TENS help Fibromyalgia?

In
addition to pain relieving drugs, there are a number of suggested treatments
for fibromyalgia ie low intensity exercise, stress reduction, dietary
supplements and acupuncture. An excellent drug free alternative is TENS.

TENS pain relief is non-invasive and drug-free method. Electrodes are placed on or near the area of pain. TENS uses
soothing pulses that are sent via the pads through the skin and along the nerve
fibres. The pulses suppress pain signals to the brain. TENS also encourages the
body to produce higher levels of its own natural pain killing chemicals ie
endorphins and encephalins.

• Early stages of pregnancy (nausea occurs in approximately 50%-90% of all pregnancies; vomiting in 25%-55%)

• Medication-induced vomiting

• Result of an anaesthetic

A TENS machine can be used to treat nausea by placing the black electrodes over an easily found acupuncture point. If you turn your hand palm up you will notice that there are two or three skin ceases where the wrist bends. Place the black electrode so that its centre is approximately 2inch above the middle of the crease which is closest to the hand. The red electrode may be placed 6inch higher or over the fleshy part of the hand just below the thumb.

Suggested TENS settings:-

Burst Mode

Pulse Rate: 100 Hz

Pulse Width:200 µs

Stimulate for between 5 minutes to 1 hour. Repeat as often as necessary to control the nausea. Try to leave at least one hour between treatments.

Most people have experienced back pain sometime in their life. The causes of back pain are numerous; some are self-inflicted due to a lifetime of bad habits. Other back pain causes include accidents, muscle strains, and sports injuries. Although the causes may be different, most often they share the same symptoms, like an ache, tension or stiffness in the back. In most cases, it gets better within 12 weeks and can usually be successfully treated by taking painkillers and keeping mobile.

A TENS machine is widely used by back pain sufferers to help manage and reduce the pain.

In TENS therapy for pain management, a small, battery-operated device delivers low-voltage electrical current through the skin via electrodes placed near the source of pain. The electricity from the electrodes stimulates nerves in the affected area and sends signals to the brain that “scramble” normal pain perception.

Suggested electrode placement and settings for LOWER BACK PAIN

Using both leads, position the electrodes either side of the spine, at the site of pain.

Electronic muscle stimulator (EMS) units use continuous electrical bursts aimed at particular muscles to force them to contract and relax. During muscle stimulation the body sends blood and oxygen to these areas and increases production of endorphins. Electronic muscle stimulator units are regularly used for Training, Rehabilitation and Recovery

SPORTS TRAINING

Dr. Y Kots of the Central Institute of Physical Culture in the former USSR conducted a study showing that electronic muscle stimulation causes contractions that are up to 30 times more powerful than normal voluntary contractions. This leads to enhanced muscle strength and improved muscle recovery.

REHABILITATION

Electronic muscle stimulator units can help rehabilitate muscles that have been injured due to traumer, surgery or disease. The contractions caused by the EMS help to strengthen muscles of individuals who may not be able to participate in physical therapy.

MUSCLE ATROPHY

Muscle atrophy is a symptom characterised by decrease in muscle mass and can occur as a result of numerous medical conditions. Electrical muscle stimulation may be used to slow or prevent the effects of muscle atrophy by keeping weakened muscles active.

OSTEOARTHRITIS

Osteoarthritis is a painful and sometimes debilitating condition caused by the degradation of joint tissues. According to a clinical study published in the “Archives of Physical Medicine and Rehabilitation,” electrical muscle stimulation was found to be an effective component of physical therapy for elderly patients who developed hip osteoarthritis after total hip arthroplasty surgery. Also an important benefit for mobility and independence, electronic muscle stimulation can strengthen knee extensor muscles.

PRESSURE SORE PREVENTION

Electrical muscle stimulation can effectively reduce the risk of pressure sores in prone patients. Pressure sores are common problems for patients who are wheelchair or bed bound. Electrical muscle stimulation can be applied to the gluteus maximus of wheelchair bound patients. This treatment can produce significant results regarding the maintenance of proper buttock shape and avoidance of deformities, which may be effective in reducing the incidence of pressure sores.

HOW DO I LOOK AFTER MY SKIN WHEN USING A TENS MACHINE?

There are very few side
effects when using a TENS machine, however occasionally mild irritation may
occur at the electrode site. This can
usually be remedied by moving the electrode position each day by just the width
of the electrode. If an allergic
reaction is experienced, try using a different make of electrode. Moisturising cream may be applied after
treatment to ease irritation, but not before.

Trim any excess body hair,
which could interfere with smooth electrode contact with the skin, but do not
shave it!

Do not place the electrodes
on broken, cut or irritated skin.

Ensure that the area of skin
where the electrodes will be placed is “oil free”. Try thoroughly cleansing the skin with soap
and water and dry well around the electrode sites.

A TENS machine specifically designed for use during labour will have a BOOST BUTTON.

It may be integral to the TENS unit or it can be a hand-held device leading from the unit.

The Boost Button is pressed whenever you have a contraction to block the pain signals sent to the brain. By pressing it you switch the signal pulse rate you feel from a low setting (2 pulses a second) to a high setting (150 pulses a second). A continuous sensation is felt with the Boost Button on.

Between contractions the Boost is turned off to return to a low pulse rate. This helps your body to continue to produce endorphins.